The days are getting darker for GPs and their patients

One of the most common complaints I get in my work with general practices, either as individual practices or through primary care networks and GP federations, is that they have too much work and they don’t have enough people in their teams to meet the ever-rising demand for their services.

What this often leads to is challenges from patients who are stuck on NHS waiting lists or in the general secondary care backlog, who want to come in and see general practice to see if there’s anything they can do to speed up their outpatient or surgical appointment.

This scenario is responsible for a huge volume of wasted appointments as it can be four or five patients in every GP session – sometimes more – who are coming in with this type of request.

GPs, as we know, have absolutely no control or influence over hospital backlogs or waiting lists.

Most hospital trusts have not met waiting targets for years

A recent report in GPOnline (subscription required) highlighted the fact that published data shows most hospital trusts have not met their waiting time targets for years – yes, literally years.

The NHS operational standard in England is that 92 per cent of patients on incomplete pathways should have been waiting no more than 18 weeks from referral.

But as GPOnline reports, data analysis by the Labour Party shows that two thirds of hospital trusts have not met that target since the 2019 general election.

The report goes on to highlight that a total of 114 trusts have not met the waiting time targets since 2019 and 22 have failed to do it since 2015.

NHS England data suggests around 6.3 million individual patients are currently waiting for more than seven-and-a-half million hospital procedures. So it’s a massive problem.

Read my blog – Win over the NHS by helping to solve the spiralling workload crisis – here

Workload uptick for GPs is not sustainable

It’s easy to imagine that if you are the patient, still suffering symptoms, the obvious choice is to go back to your GP and ask them if they can hurry things up. But, as we’ve said, there’s absolutely nothing a GP can do to speed up what’s happening in a hospital.

You’ve also got to remember that we now have record numbers of people being seen in general practice day to day, often in excess of one million appointments a day. It’s the only part of the NHS delivering more activity than it was pre-pandemic.

General practice is currently running at around 20 per cent more appointments than it was before Covid and that simply isn’t sustainable. We’re not seeing the same pattern in the hospital trusts where most of them have yet to return to their pre-pandemic levels.

On top of that, we’re also seeing an ever-increasing level of what are deemed to be inappropriate request from hospitals for practices to do things like carry out tests and organise follow-ups.

I’ve never heard as much discussion about these types of inappropriate requests as I am hearing at the moment. It’s viewed as unfunded work and it runs alongside other unfunded work that practices are just expected to do, turning the screw even tighter.

Practices stretched beyond breaking point

As a result, practices are refusing to meet requests to undertake unfunded work, as it threatens their very existence. Practices are even handing back their contracts because they are no longer sustainable and viable. This happened very recently in Cambridge.

Many of my general practice customers are now advising that they are stretched beyond breaking point.

This is an absolute nightmare for a patient. If your practice just evaporates, you’ll have to try to register at another local practice.

Even if your current practice is taken over, there’s no guarantee the new people running it will offer the same kind of access and support you had previously received under the GP partnership that held the contract.

GPs had another contract imposition in 2024, their third in three years. The uplift was 1.9% and we’re now finding GPs out of work and unable to secure roles simply because the money isn’t there in general practice to employ them because of the contract imposition.

As a result, GPs are being pushed to the brink of collective action. The BMA general practitioners committee (GPC) is looking at the situation right now because the government is simply refusing to get back around the table and try to renegotiate the 2024/25 GP contract.

Only a couple of weeks ago the BMA GPC in England voted for a non-statutory ballot of GP partners, over-taking collective action that could include capping daily appointments and scaling back the working practices they’re not formally contracted to deliver. Unfunded work would be part of that.

The numbers don’t add up – and the gap is getting wider

The online ballot runs until July 29 and it asks partners whether they are prepared to take what’s deemed “a safe and legal action to protect their practices and their patients”.

The BMA is saying that if there is a majority vote in favour, they will be able to take action immediately and I’m hearing that could be as immediate as August, as soon as they get the go-ahead.

They have made it clear they will not break their contract, at least not in the initial phase of any action.

As a backdrop too all this, it’s worth remembering that the “safe limit” for a GP is basically capped at 1,800 patients. If a practice has 18,000 patients, they should have a minimum of 10 full-time equivalent GP partners.

The BMA says that figure needs lowering because there is rising morbidity and frequency of patient consultations.

GPOnline looked in detail at what that change could mean for GPs. They looked at the workforce data for March this year which showed there are currently 2,295 registered patients per fully qualified full-time equivalent GP in England. So that’s more than 25% above the 1,800 patients viewed as the safe limit.

GPOnline then went further and said that in order to close that gap to the safe limit of 1,800 patients, approximately 7,000 additional fully qualified full-time equivalent GPs would be needed.

If they were to lower it, as per the BMA’s request, and it went to 1,700, it would take around 9,500 extra full-time equivalent GPs and if it moved to 1,600 patients, we would need another 12,000 full-time equivalent GPs.

When you consider that since 2016 we’ve lost 3,000 full-time equivalent GPs, you begin to appreciate how far away we are from those kinds of numbers.

Those figures incidentally are based on current population registered with general practice. Between March 2019 and March 2024, GP practices in England grew by almost 3.5million patients, a six per cent increase, so those numbers are probably already out of date and even worse than they look.

Pharma, MedTech and Device firms need to stay alert

It’s going to be very interesting to see the outcome of the ballot, but if my work is anything to go by, I would expect huge support for some form of collective action.

All I will say is watch this space because as soon as we know the result of the ballot and what that collective action is likely to be I will come back with an update for the Pharma, MedTech and Device companies with some thoughts on the impact this is likely to have.

We have to be aware of what’s coming because anything that affects access into general practice is likely to have a knock-on effect in terms of their willingness to take on new projects.

Scott McKenzie helps pharmaceutical, medical technology and appliance firms get their products and services in front of the right NHS decision makers. He helped to land no fewer than 53 new projects with the NHS in 2023 alone and has now developed a 12-month mentorship programme that helps individuals and teams get straight to the heart of the challenges of selling to the NHS. If you want to get your products fully embedded into treatment pathways, Scott can help. Get unprecedented access to key customer insights, proven tools, resources and strategies plus 1-2-1 coaching and decision-maker introductions to finally get your project over the line. Find out more here.